Back

My 33-year-old son was involved in a bad motorcycle accident. He really got hurt bad. I don't understand with all the injuries he had to his knee why they haven't operated on him yet. It's been almost a week now since he's been in the hospital. What's the hold-up?

Knee injuries so severe that there is dislocation, fracture, and/or multiple ligaments ruptured require careful consideration when planning treatment. The surgeon must quickly but thoroughly assess the extent of damage to the bones, soft tissues, nerves, and blood vessels in the leg. Knee dislocations are notorious for causing nerve injury even when the patella (knee cap) automatically reduces (goes back into place). Tools used to conduct the evaluation begin with visual inspection (e.g., location of the injuries, signs of blood loss) and include testing for blood supply (e.g., Doppler, CT angiography, ultrasound). The presence of any damage to blood vessels or loss of blood supply to the area means a vascular surgeon must scrub up along with the orthopedic surgeon to perform the necessary procedures. Before surgery can be done, X-rays and MRIs are taken to identify the extent of ligament injury (location and severity). This information helps the surgeon plan what must be done in the operating room. A plastic surgeon may be needed if there has been so much soft tissue damage that the wound can't be closed without a graft. Sometimes there are torn or ruptured ligaments that get put on the back burner (repaired later) because of the need to restore blood supply and save the leg first. Most complex injuries with fracture, dislocation, and/or ligament rupture of the knee require staged procedures. That means everything that needs to be done can't be completed in one day or during one operation. They try and treat any fractures or dislocations the first day. Blood supply is restored and stabilized. Reconstruction of soft-tissue injuries may be delayed for up to one week before the next stage of treatment can begin. Ligament reconstruction (phase three) takes place three to four weeks later. There may even be a stage or phase four if the knee is still unstable and further reconstruction is needed.

« Back